Systemic inflammatory indexes as predictors of 18-month mortality among cirrhotic patients receiving transjugular intrahepatic portosystemic shunt

To investigate the relationship between inflammatory/nutritional indexes and 18-month mortality in cirrhotic patients undergoing the transjugular intrahepatic portosystemic shunt (TIPS) procedure, and to develop a predictive nomogram. Lasso and stepwise multivariate Cox regression analyses were employed to identify prognostic determinants and construct a visual prognostic nomogram. Clinical data from 2017 to 2022 were utilized for model development, while data from 2023 were for validation. The performance of nomogram was assessed using the concordance index (C-index), the area under the curve (AUC), calibration curves, DeLong test, decision curve analysis (DCA), net reclassification improvement (NRI), integrated discrimination improvement (IDI) indexes, Kaplan–Meier curves, and the integrated Brier scores. We retrospectively included 249 patients for the development of nomogram and 66 for validation. Inflammatory indexes (systemic immune-inflammation index [SII], neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], lymphocyte-to-white blood cell ratio [LWR], neutrophil percentage-to-albumin ratio [NPAR], prognostic nutritional index [PNI]) were significantly correlated with mortality. Nomogram 1 incorporated the Child-Pugh score and SII, whereas Nomogram 2 included age, Child-Pugh, and SII. The C-index value for 18-month mortality were 0.79 and 0.82 for Nomogram 1 and Nomogram 2 respectively. The AUC for 6-, 12- and 18-month were 0.759, 0.829, 0.806 in Nomogram 1 and 0.782, 0.834 and 0.834 in Nomogram 2. Nomogram 2 was regarded as the final model for superior predictive performance. Calibration and DCA curves demonstrated its consistency and clinical utility. DeLong analysis confirmed statistical superiority of Nomogram 2 over Child-Pugh score alone. NRI and IDI analyses further supported the added prognostic value of SII. High-risk patients stratified by Nomogram 2 showed significantly reduced survival (<i>p</i> &lt; 0.001). We identified systemic inflammatory indexes as significant prognostic biomarkers for disease-specific mortality post-TIPS. A predictive nomogram was constructed and validated with strong discriminative efficacy for risk stratification of death.